Thursday, October 30, 2014

Ebola: Distrust and Misinformation

Distrust and misinformation have been prominent throughout the Ebola outbreak, and something that we have touched on in previous blog posts. Distrust for the government and international community, and a lack of clear information about the sources, the transmission, and the care for Ebola. It can be difficult for an outsider to fully understand the social and political history that has lead to this environment of distrust, so in this blog post I hope to reveal some of the contributing factors in the formation of these conspiracies.This blog comes after a week in which several ambulances, transferring suspected Ebola patients from their communities to treatment centres, have been attacked. The ambulances have been mobbed, and turned over, by youths desperately trying to prevent the health professionals from taking their loved ones to hospital, with the claim that they are not suffering from Ebola.

This was the 4th Ambulance to be attacked along the Port Loki road as family members attempted to stop health professionals from taking their loved ones away, claiming that they were not suffering from Ebola.

In an article with the American Radio Station, NPR, Dr. Daniel Bausch – a prominent virologist who works extensively in sub-Saharan Africa – outlined some of the scepticism and rumours that they are facing from the local population about Ebola. Dr. Bausch, reflecting on the group of health workers and journalists were attacked and killed in southern Guinea, explained that some people believe “[the medical professionals are] bringing in the disease, or that the disease doesn't exist at all and this is just an excuse, basically, to control populations, to get more research dollars.” He also asserted that “One of the common [rumours] is we're harvesting organs.”

It sounds far-fetched for our Western sensibilities, but it is important that we investigate the context of these rumours, and why they lead to the very real circumstances portrayed in the picture above. Dr. Bausch suggests that they are caused by a lack of clear information about the disease, the methods of transmission, and the realistic expectations of cure. He suggests that this provides some explanation of why people in West Africa could believe that there is a greater conspiracy at work.

“…you can see a little bit of the idea. When you have a disease that has a high case fatality, the people go into a treatment centre isolation ward, most people don't come out alive. So people attribute causality to that. They say, ‘Whatever you do, don't go in there, because if you go in there you're going to die.’”

Ebola is a virulent disease, and one with an extraordinarily high mortality rate. Even with quality medical facilities and ample resources, Dr. Bausch says that “I don’t think we should be naïve. It's not going to be something where we get it down to a few percentage points; it's still going to be a very serious disease…[20%] seems a bit ambitious to me.” With the mortality rate of around 66% in Sierra Leone, it is widely perceived that these medical centres are ineffectual. There is a sad fact that comes across in the interview with Dr. Bausch: due to the lack of resources and organisation on the ground, the treatment centres in West Africa are more effective acting as quarantine centres, than they are for treatment of the virus.

“What we've been doing now is ratcheting down the idea of what care really means, not because we want to but because we have to. Many, not all, but many of the places right now, if you get sick with Ebola, it's not at all the care that we want to give, where a doctor examines you and says, "OK, you need some IV fluids" and things like that. We just don't have the capacity. Right now it's to give people a bed, hopefully some food and some water and some analgesics — some Tylenol — for pain, and some oral re-hydration solution, and to get them out of circulation so they don't infect more people.

And is that the way we want it to be? Of course not.”

As the severity of the outbreak worsens, the greater the strain will be on the medical services. Unfortunately, without further international assistance, the mortality rate will create more and more discontent within the country. It becomes very easy to understand why people don’t see the care centres as a viable option, because more often than not it is the last time a family will see their loved one.

Cheikh Ibrahima Niang, a leading professor in social anthropology, says that "The virus is biological, but the virus alone is not the epidemic." He explains that the "context" in which the Ebola has spread is "favourable" for an epidemic. He explains:

“People have the impression that they are not getting all the necessary information or they do not agree with the prevention measures and medical procedures being imposed on them…The problem is not that locals don’t accept medicine can work, it’s that they are mistrustful of an invading culture coming into their homeland telling them how they should behave…They are in situations where they were not consulted and feel that they are treated with a lot of paternalism.”

Dr. Bausch also draws on the fact that colonialism is still a very recent event for those in West Africa. While Westerners can often look at Colonialism as the crimes of a past generation, those that live in the countries see it’s effects every day. The very fact that an organisation such as EducAid is required in a country as wealthy in diamond and mineral resources as Sierra Leone is, points to an unnatural, imbalanced, and troubled history.

The Ministry of Health and Sanitation for Sierra Leone issued a press release last Thursday updating the public on a change in containment strategy, we spoke about this press release in our post last Thursday:

“Due to the number of new Ebola cases in Western Area, Western Area is now considered an Ebola High Transmission Area. This means that certain measures have been put in place.

Below are the key points:

CDC have reported that 70-80% of all new Ebola cases nationally are caused by people having contact with the bodies of those who have died from Ebola, and this % is increasing.

In order to reduce new infections we have to reduce the number of people who have contact with the bodies of the deceased.

Now that Western Area is considered a High Transmission Area:

All deaths have to be treated as suspected Ebola deaths (even if the family know the death was caused by old-age or another illness).

All bodies of the deceased must be removed from the community by the burial teams, ASAP, and always within 24 hours.

It is not possible to do a swab test on all bodies to learn whether the cause of death was Ebola or not before a body is removed from the home. It takes between 1-3 days to get the test results back from the labs, and 1-3 days is too long to leave the body in the house.”

This new strategy marked a clear tightening of security measures – to treat all deaths as severely as Ebola, and to clear all bodies within 24 hours. Whilst this appears to be a positive step in solving the on-going containment problem, there have been problems in the execution of it. One facebook comment that I have read this week gives us a more pertinent and direct example how the pragmatic route is not the most sympathetic - our thoughts and hearts go out to this person and their family.

“This morning, just as I was getting ready to start my day, I got a call from my mother to say that my Aunt had died of Ebola. I was saddened but not angry. When she got sick she was taken away from the family house and, when she died, she was buried without the family knowing where. No information has been made available to the family as to how her gravesite can be identified so that family members can visit it and say prayers. I consider this an act of disrespect and indignity upon our family and, for that matter, each and every family that has been subjected to such indignities by the poorly trained and unethical burial teams.

This virus itself, by the manner that it quietly infects its victims, the swiftness with which it kills its victims, and the mere fact that its victims are shunned even by their own kith and kin at a time when they need that support the most, has wrought some indignities on the victims of the disease. My suggestion is that the appointees must ensure that it does not victimize the survivors of these victims Just when we were beginning to gain confidence in the efforts, the deficits of poor planning are still showing their ugly heads.

Survivors of victims must be properly informed prior to the internment of victims and the graves of victims must be properly marked and identified.”

Despite the Ministry of Health and Sanitation implementing these measures in an earnest attempt to control the contagion, it becomes clear that there have, so far, been gaps in protocol. Family members are not being given the time to grieve and bury their loved ones – this must be a particularly difficult concession when their loved one has been taken in such a devastating manner. We can see that there is a disparity between what we, in the West, perceive as progressive, and what those that are being most directly affected see as effective. If you have genuine doubts about the effectiveness of the ‘state-endorsed’ method of care, and you feel disillusioned from the state apparatus and the international invasion, one can begin to understand the thought-process that would lead a gang of youths to overturn an ambulance on it’s way to a treatment centre.

Having said all of that, this is simply not right. EducAid takes it’s position in the community very seriously, and we feel it is our duty to spread as much productive information as possible. Ebola is real. Ebola is deadly. Ebola can be avoided. By avoiding physical contact with any symptomatic sufferer of Ebola, you will remain safe. Bodies are at their most contagious at the point of death, so do not touch or wash the bodies once the symptoms of Ebola have appeared. We are in the middle of a health crisis, and we need to be selfless so that Sierra Leone and other West African countries can move on together, stronger, after Ebola. This may mean that we need to leave loved ones to be quarantined, but we must accept that this their care is being carried out to within the greatest means available to the health workers that are administering it. Every time a health worker pulls on protective gear, and walks around a ward, they are endangering their own lives. The same goes for contact tracers, and for burial teams. People will make mistakes, and protocol will break down, but me must be patient and selfless so that the country can get better as a whole.

The British Army has delivered on it’s pledge of 750 military personnel, many of whom are medics already engaged in the training of more health professionals. Others are training the local burial teams in the safe and dignified manner of burial, and one that will allow a small gathering of the family to attend a funeral from a safe distance. It is an important and critical strategy that the Ministry of Education has outlined in their press release, and one that will prove effective in the fight against Ebola. It has been widely documented that containing people who are suffering from the virus quickly is the best way to stop, but the local and international bodies must ensure that we retain the empathy that we instantly feel for these families, because it is a movement that needs the local population to drive it forwards rather than to repel it back.

We know that thousands of people are being affected by Ebola, and we are concerned that people are only thinking about the immediate consequences. Unlike many of the international organisations that are doing such fantastic work to contain Ebola, we are a Sierra Leonean organisation, and we are in the position to initiate change for the future. It has been identified that, as primary carers, many women are dying from Ebola, and this has concerned us. What happens to the dependents when a mother dies?

We are raising money to provide education, accommodation, and psychological care for those most seriously affected by Ebola – the children. WE need your help to raise £150,000 so that we can instrument our 3 step program to life #AfterEbola.

Please give generously, because every penny that you donate comes directly to Sierra Leone. With 180 and 3000 students around the country, we really are in the position to initiate change in this country from within.